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        <h1>
            Diarrhoea</h1>
        <h5 class="updated">
            Last updated: Saturday, 27, November, 2010</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Causes</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                </td>
                <td class="second">
                    If severe dehydration requiring fluid replacement is present: <b>electrolytes, 
                    urea</b>.</td>
            </tr>
            <tr>
                <td class="first">
                    <strong>Acute</strong></td>
                <td class="second">
                    <p>
                        Testing is only indicated when diarrhoea is severe or persistent, or if the 
                        patient requires hospitalisation.</p>
                    <p>
                        Testing may also be appropriate when an epidemic is suspected.</p>
                    <p>
                        The selection of tests should take recent travel into account - consult 
                        pathologist.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Infection</p>
                    <ul>
                        <li>Viral</li>
                        <li>Bacterial</li>
                        <li>Protozoal</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        &nbsp;</p>
                    <p>
                        <b>Faeces - microscopy, culture and antigen detection</b>, if indicated.</p>
                    <p>
                        <b>Blood culture</b>, if indicated.</p>
                    <p>
                        <b>Faeces - ova, cysts and parasites.</b></p>
                    <p>
                        If endoscopy is indicated: <b>biopsy</b> of involved bowel. See also
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=254&amp;Itemid=27" 
                            target="_blank">Giardiasis</a>,
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=49&amp;Itemid=27" 
                            target="_blank">Amoebiasis</a></p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Antibiotic-associated</p>
                    <ul>
                        <li>Pseudomembranous colitis</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        Diarrhoea of varying severity is a common adverse effect of antibiotics.</p>
                    <p>
                        If severe and/or persistent: <b>faeces - microscopy, culture and antigen 
                        detection and/or <em>Clostridium difficile</em> toxin.</b></p>
                    <p>
                        If endoscopy is indicated: biopsy of involved bowel.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Food poisoning</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <strong>Chronic</strong></td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Infection</p>
                    <ul>
                        <li>Bacterial</li>
                        <li>Protozoal</li>
                    </ul>
                    <p>
                        Inflammatory</p>
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=560&amp;Itemid=27" 
                                target="_blank">Ulcerative colitis</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=163&amp;Itemid=27" 
                                target="_blank">Crohn’s disease</a></li>
                        <li>Ischaemic colitis</li>
                        <li>Radiation proctitis</li>
                        <li>Lymphocytic colitis</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                    </p>
                    <p>
                        <b>Faeces - microscopy, culture and antigen detection.</b></p>
                    <p>
                        <b>Faeces - ova, cysts and parasites.</b></p>
                    <p>
                        If endoscopy is indicated: <b>biopsy</b> of involved bowel.</p>
                    <p>
                        See also
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=254&amp;Itemid=27" 
                            target="_blank">Giardiasis</a>,
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=49&amp;Itemid=27" 
                            target="_blank">Amoebiasis</a></p>
                    <p>
                        &nbsp;</p>
                    <p>
                        &nbsp;</p>
                    <p>
                        <b>Colorectal biopsy; electrolytes -faeces.</b></p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Disaccharide intolerance</p>
                </td>
                <td class="second">
                    <p>
                        <b>Faeces - reducing substances and pH.</b></p>
                    <p>
                        Small bowel <b>biopsy</b> with measurement of disaccharidases.</p>
                    <p>
                        Sugar tolerance tests, with assay of breath hydrogen or plasma glucose, are less 
                        frequently used.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=424&amp;Itemid=27" 
                            target="_blank">Malabsorption</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        HIV infection</p>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=322&amp;Itemid=27" 
                        target="_blank">HIV infection</a> and
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=41&amp;Itemid=27" 
                        target="_blank">AIDS</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Secondary infection</li>
                        <li>HIV wasting syndrome</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        <b>Faeces - ova, cysts and parasites; faeces - microscopy, culture and antigen 
                        detection, mycobacteria testing.</b></p>
                    <p>
                        <b>Biopsy</b> of bowel for evidence of CMV, protozoal or mycobacterial 
                        infection, if indicated.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Irritable bowel</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=361&amp;Itemid=27" 
                            target="_blank">Hyperthyroidism</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Autonomic neuropathy, especially&nbsp;</p>
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=184&amp;Itemid=27" 
                                target="_blank">Diabetes mellitus</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Islet cell (non-beta) tumour</p>
                </td>
                <td class="second">
                    <p>
                        <b>Electrolytes - faeces. Gastrointestinal hormones</b> (eg, vasoactive 
                        intestinal polypeptide) - consult pathologist.</p>
                    <p>
                        See also&nbsp;<a 
                            href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=499&amp;Itemid=27" 
                            target="_blank">Pancreatic neoplasm</a>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Drugs, especially&nbsp;</p>
                    <ul>
                        <li>Laxative abuse</li>
                        <li>Colchicine</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        Assay of possible drugs in urine; consult pathologist.
                    </p>
                    <p>
                        <b>Laxatives - urine; magnesium faeces.</b></p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=271&amp;Itemid=27" 
                            target="_blank">Graft versus host disease</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=237&amp;Itemid=27" 
                            target="_blank">Food intolerance/allergy</a></p>
                </td>
                <td class="second">
                    Rarely a cause of chronic diarrhoea.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <strong>Bloody</strong></td>
                <td class="second">
                    <b>Faeces microscopy, culture and antigen detection.</b></td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Infection, especially</p>
                    <ul>
                        <li><em>Campylobacter jejuni</em></li>
                        <li>Enterohaemorrhagic <em>Escherichia coli</em></li>
                        <li><em>Shigella</em> spp</li>
                        <li><em>Entamoeba histolytica</em></li>
                    </ul>
                    <p>
                        <b>Inflammatory</b></p>
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=560&amp;Itemid=27" 
                                target="_blank">Ulcerative colitis</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=163&amp;Itemid=27" 
                                target="_blank">Crohn’s disease</a></li>
                        <li>Ischaemic colitis</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        &nbsp;</p>
                    <p>
                        See
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=49&amp;Itemid=27" 
                            target="_blank">Amoebiasis</a></p>
                </td>
            </tr>
            <tr class="odd-last">
                <td class="first">
                    <p>
                        Neoplasia, including</p>
                    <ul>
                        <li>Polyps</li>
                        <li>Colorectal carcinoma</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        Lesion <b>biopsy</b> at endoscopy.</p>
                    <p>
                        <b>Carcinoembryonic antigen</b> for monitoring course.</p>
                    See also
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=104&amp;Itemid=27" 
                        target="_blank">carcinoma</a> -Colonic carcinoma</td>
            </tr>
        </table>
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            <h2>
                Glossary Terms</h2>
            <div>
                <h4>
                    AIDS:</h4>
                <p>
                    Acquired immunodeficiency syndrome</p>
                <h4>
                    CMV :</h4>
                <p>
                    Cytomegalovirus</p>
                <h4>
                    HIV :</h4>
                <p>
                    Human&nbsp;immunodeficiency&nbsp;virus</p>
            </div>
        </div>
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